​To: Governors of California, Nevada, Oregon, and Washington State

• Governor Gavin Newsom, California
  

• Governor Steve Sisolak, Nevada
  

• Governor Kate Brown, Oregon
  

• Governor Jay Inslee, Washington
  

From: Arthur Reingold, MD, Chair, Western States Scientific Safety Review Workgroup

At its meetings on September 23 and 24, 2021, the Western States Scientific Safety Review Workgroup reviewed the evidence concerning booster doses of the Pfizer-BioNTech COVID-19 vaccine presented at the meetings of the federal Vaccines and Related Biological Products Advisory Committee (VRBPAC) on September 17, 2021 and Advisory Committee on Immunization Practices (ACIP) on September 22 and 23, 2021 and the statement of CDC Director Rochelle Walensky on September 23, 2021.

To sustain protection against COVID-19, especially among those at increased risk for hospitalization and severe disease, the Workgroup concurs with CDC recommendations for a single Pfizer-BioNTech COVID-19 vaccine booster dose, given under FDA Emergency Use Authorization at least 6 months after a primary series for the following persons:

Those who should receive a booster dose

• Age 65 years and older or residing in a long-term care facility, or
  

• Age 50 through 64 years with underlying medical conditions or at increased risk of social inequities.

Those who may receive a booster dose

• Age 18 through 64 years
  

• with underlying medical conditions, or
  

• who are at increased risk for SARS-CoV-2 exposure and transmission because of occupational or institutional setting.

The Workgroup strongly endorses CDC‘s recognition that long-standing systemic health and social inequities have increased the risk of severe illness from COVID-19. The Workgroup therefore recommends that social determinants of vulnerability be included in the assessment of conditions that qualify individuals for booster doses.

Because unvaccinated persons remain at much higher risk of COVID-19 than those who have received COVID-19 vaccines, the Workgroup continues to strongly support vaccination against COVID-19 for everyone 12 years of age and older to control the pandemic.

The Workgroup recognizes that current federal authorization and guidance for a booster dose is currently limited to use of the Pfizer-BioNTech mRNA COVID-19 vaccine. The Workgroup continues to implore FDA, CDC and ACIP to promptly find solutions to sustain the protection of vulnerable persons who have received the Janssen or Moderna COVID-19 vaccine, including the possible option of heterologous schedules.

The Workgroup is very concerned that the limited global supply of COVID-19 vaccines is hampering pandemic control efforts in low resource countries and increasing the risk of emergence of new variants of SARS-CoV-2 that could spread worldwide. The Workgroup applauds the donation to date of supplies of COVID-19 vaccine doses to nations in need and calls for an expansion of these efforts to protect our global community.

Respectfully submitted: 

Members of the Western States Scientific Safety Review Workgroup:

Arthur Reingold, MD, Chair, UC Berkeley School of Public Health

California Members:

• Tomás J. Aragón, MD, DrPH, California Department of Public Health and State Health Officer
• Eric Goosby, MD, UCSF School of Medicine
• Rodney Hood, MD, UC San Diego Alumnus and National Medical Association
• Nicola Klein, MD, Ph.D., Kaiser Permanente Northern California
• Grace M. Lee, MD, MPH, Stanford Children’s Health and Stanford University School of Medicine (not present at September 23 and 24, 2021 Western States Workgroup meeting)
• Bonnie Maldonado, MD, Stanford University School of Medicine and Stanford Children’s Health
• Mark H. Sawyer, MD, UC San Diego School of Medicine and Rady Children’s Hospitals
• Robert Schechter, MD, California Department of Public Health
• Peter G. Szilagyi, MD, MPH, UCLA Health and David Geffen School of Medicine
• Matt Zahn, MD, Orange County Health Care Agency (not present at September 23 and 24, 2021 Western States Workgroup meeting)

Nevada Members:

• Ihsan Azzam, MD, Ph.D., Chief Medical Officer, State of Nevada (not present at September 23 and 24, 2021 Western States Workgroup meeting)
• Karissa Loper, MPH, Health Bureau Chief, Nevada Department of Health and Human Services (not present at September 23 and 24, 2021 Western States Workgroup meeting)

Oregon Members:

• Laura Byerly, MD, Virginia Garcia Memorial Health Center
• Louis J. Picker, MD, OHSU Vaccine and Gene Therapy Institute

Washington Members:

• John Dunn, MD, MPH, Kaiser Permanente Washington
• Edgar K. Marcuse, MD, MPH, University of Washington School of Medicine

​​​​Originally published September 24, 2021